HOUSE DOCKET, NO FILED ON: 1/15/2015. HOUSE... No The Commonwealth of Massachusetts PRESENTED BY: Garrett J. Bradley

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1 HOUSE DOCKET, NO FILED ON: 1/15/2015 HOUSE No. 970 The Commonwealth of Massachusetts PRESENTED BY: Garrett J. Bradley To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General Court assembled: The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill: An Act to promote accessible substance abuse treatment for all. PETITION OF: NAME: Garrett J. Bradley James M. Cantwell Robert M. Koczera Tackey Chan Timothy R. Madden John V. Fernandes RoseLee Vincent Joseph W. McGonagle, Jr. Claire D. Cronin Joseph D. McKenna Thomas M. Stanley Jose F. Tosado James R. Miceli Paul J. Donato James J. Dwyer Angelo J. Puppolo, Jr. Frank A. Moran Michael O. Moore DISTRICT/ADDRESS: 3rd Plymouth 4th Plymouth 11th Bristol 2nd Norfolk Barnstable, Dukes and Nantucket 10th Worcester 16th Suffolk 28th Middlesex 11th Plymouth 18th Worcester 9th Middlesex 9th Hampden 19th Middlesex 35th Middlesex 30th Middlesex 12th Hampden 17th Essex Second Worcester 1 of 12

2 Louis L. Kafka Walter F. Timilty Tricia Farley-Bouvier Chris Walsh Ruth B. Balser Jason M. Lewis Brendan P. Crighton Bruce E. Tarr James M. Murphy Jennifer L. Flanagan Marjorie C. Decker Jeffrey N. Roy David M. Rogers Paul R. Heroux 8th Norfolk 7th Norfolk 3rd Berkshire 6th Middlesex 12th Middlesex Fifth Middlesex 11th Essex First Essex and Middlesex 4th Norfolk Worcester and Middlesex 25th Middlesex 10th Norfolk 24th Middlesex 2nd Bristol 2 of 12

3 HOUSE DOCKET, NO FILED ON: 1/15/2015 HOUSE No. 970 By Mr. Bradley of Hingham, a petition (accompanied by bill, House, No. 970) of Garrett J. Bradley and others relative to public health, substance abuse, treatment and opioids and accessible substance abuse treatment for all. Health Care Financing. The Commonwealth of Massachusetts In the One Hundred and Eighty-Ninth General Court ( ) An Act to promote accessible substance abuse treatment for all. Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows: 1 SECTION 1. Chapter 15 of the General Laws is hereby amended by adding the following 2 sections:- 3 Section 67. There shall be a Behavioral Health Education and Prevention Task Force 4 charged with reviewing national best practices in regards to behavioral health prevention plans 5 and educational curricula appropriate for schools and school-based settings. The task force shall 6 be composed of the commissioner of elementary and secondary education, or a designee, who 7 shall serve as chair; the commissioner of public health, or a designee; the commissioner of 8 mental health, or a designee, and nine members to be appointed by the governor, including one 9 representative each of the following organizations; the Massachusetts School Nurse Association, 10 the Massachusetts Association for School-Based Health Care, the Massachusetts chapter of the 11 National Association of Social Workers, the Massachusetts Association of School Committees, 12 and the Massachusetts Association of School Superintendents; and, one expert in substance 3 of 12

4 13 abuse treatment for adolescents and young adults, one expert in mental health treatment for 14 adolescents and young adults, and two persons with lived behavioral health experience as 15 students. At least one-half of the total appointed members of the task force shall constitute a 16 quorum for the transaction of business. Appointees shall serve without compensation. 17 The task force shall meet, at a minimum, quarterly, and shall develop and publish 18 recommended best practices, model school prevention plans, and educational curricula related to 19 behavioral health, appropriate for schools and school-based settings. The task force shall provide 20 new or revised materials, recommendations, and model plans at least every five years, or as 21 nationally recognized best practices evolve. The task force shall also, upon request, provide 22 school districts that choose to implement such plans with information and technical assistance. 23 Section 68. There is hereby established, subject to appropriation, a Behavioral Health 24 School Education and Prevention Incentive Grant program for the purpose of providing grants to 25 public schools and school districts, through a competitive process, that choose to implement a 26 locally-appropriate behavioral health school education and prevention plan based on 27 recommendations as established by the Behavioral Health Education and Prevention Task Force 28 pursuant to section 67 of this chapter. Program funds may be used by the department for the 29 purpose of administering the grant program, provided, however, that administration costs shall 30 not exceed 10 percent of the total fund, or, the cost of one full-time equivalent employee, 31 whichever is greater. The department, in consultation with said task force, shall promulgate 32 regulations governing the administration of the grant program. 33 SECTION 2. Chapter 32A of the General Laws, as amended by chapter 258 of the acts of , is hereby amended by inserting after section 17N the following section:- 4 of 12

5 35 Section 17O. For the purposes of this section the following terms shall have the 36 following meanings:- 37 Methadone treatment program, an opioid treatment program as defined in 105 CMR , a SAMHSA-certified program, licensed by the department of public health, usually 39 comprised of a facility, staff, administration, patients, and services, that engages in supervised 40 assessment and treatment using approved medications, of individuals who are addicted to 41 opioids. 42 SAMHSA, the Substance Abuse and Mental Health Services Administration. 43 Any coverage offered by the commission to an active or retired employee of the 44 commonwealth insured under the group insurance commission shall provide coverage for 45 buprenorphine, injectable naltrexone, and methadone treatment programs, provided that the total 46 out-of-pocket cost charged to enrollees in the form of co-payments for methadone treatment 47 programs shall not exceed 20 per cent of the total reimbursement paid to the methadone 48 treatment program provider for such services. 49 Any coverage offered by the commission to an active or retired employee of the 50 commonwealth insured under the group insurance commission shall provide reimbursement to 51 methadone treatment programs for buprenorphine and injectable naltrexone provided to an 52 enrollee. 53 SECTION 3. Section 1 of chapter 111E of the General Laws is hereby amended by 54 adding after the definition of Independent Physician the following definition:- 5 of 12

6 55 Opioid Treatment Center, an opioid treatment program as defined in 105 CMR , a SAMHSA-certified program, licensed by the department of public health, usually 57 comprised of a facility, staff, administration, patients, and services, that engages in supervised 58 assessment and treatment using approved medications, and which also include the provision of 59 buprenorphine and injectable naltrexone, for the treatment of individuals who are addicted to 60 opioids. 61 SECTION 4. Chapter 118E of the General Laws, as amended by chapter 258 of the acts 62 of 2014, is hereby amended by inserting after section 10H the following section:- 63 Section 10I. For the purposes of this section the following terms shall have the following 64 meanings:- 65 Methadone treatment program, an opioid treatment program as defined in 105 CMR , a SAMHSA-certified program, licensed by the department of public health, usually 67 comprised of a facility, staff, administration, patients, and services, that engages in supervised 68 assessment and treatment using approved medications, of individuals who are addicted to 69 opioids. 70 SAMHSA, the Substance Abuse and Mental Health Services Administration. 71 The division and its contracted health insurers, health plans, health maintenance 72 organizations, behavioral health management firms and third party administrators under contract 73 to a Medicaid managed care organization or primary care clinician plan shall cover the cost of 74 buprenorphine, injectable naltrexone, and methadone treatment programs, provided that the total 75 out-of-pocket cost charged to enrollees in the form of co-payments for methadone treatment 6 of 12

7 76 programs shall not exceed 20 per cent of the total reimbursement paid to the methadone 77 treatment program provider for such services. 78 The division and its contracted health insurers, health plans, health maintenance 79 organizations, behavioral health management firms and third party administrators under contract 80 to a Medicaid managed care organization or primary care clinician plan shall provide 81 reimbursement to methadone treatment programs for buprenorphine and injectable naltrexone 82 provided to an enrollee. 83 SECTION 5. Chapter 125 of the General Laws is hereby amended by adding the 84 following section:- 85 Section 22. Notwithstanding any general and special law to the contrary, any substance 86 abuse treatment program operating within a state correctional facility must be licensed by the 87 department of public health. 88 Notwithstanding any general or special law to the contrary, all state correctional facilities 89 must utilize substance abuse detoxification protocols and procedures submitted to and approved 90 by the department of public health. The department of public health may issue regulations or 91 guidance governing the process for submission and approval of such protocols and procedures, 92 and may grant exemptions or waivers to this requirement at the discretion of the commissioner of 93 public health. 94 SECTION 6. Chapter 126 of the General Laws is hereby amended by adding the 95 following section:- 7 of 12

8 96 Section 40. Notwithstanding any general or special law to the contrary, any substance 97 abuse treatment program operating within a jail, house of correction and reformation, or county 98 industrial farm established under this chapter must be licensed by the department of public 99 health. 100 Notwithstanding any general or special law to the contrary, all jails, houses of correction 101 and reformation, or county industrial farms established that perform substance abuse 102 detoxification under this chapter must utilize substance abuse detoxification protocols and 103 procedures submitted to and approved by the department of public health. The department of 104 public health may issue regulations or guidance governing the process for submission and 105 approval of such protocols and procedures, and may grant exemptions or waivers to this 106 requirement at the discretion of the commissioner of public health. 107 SECTION 7. Chapter 175 of the General Laws, as amended by chapter 258 of the acts of , is hereby amended by inserting after section 47GG the following section:- 109 Section 47HH. For the purposes of this section the following terms shall have the 110 following meanings:- 111 Methadone treatment program, an opioid treatment program as defined in 105 CMR , a SAMHSA-certified program, licensed by the department of public health, usually 113 comprised of a facility, staff, administration, patients, and services, that engages in supervised 114 assessment and treatment using approved medications, of individuals who are addicted to 115 opioids. 116 SAMHSA, the Substance Abuse and Mental Health Services Administration. 8 of 12

9 117 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or 118 renewed within the commonwealth, which is considered creditable coverage under section 1 of 119 chapter 118M, shall provide coverage for buprenorphine, injectable naltrexone, and methadone 120 treatment programs, provided that the total out-of-pocket cost charged to enrollees in the form of 121 co-payments for methadone treatment programs shall not exceed 20 per cent of the total 122 reimbursement paid to the methadone treatment program provider for such services. 123 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or 124 renewed within the commonwealth, which is considered creditable coverage under section 1 of 125 chapter 118M, shall provide reimbursement to methadone treatment programs for buprenorphine 126 and injectable naltrexone provided to an enrollee. 127 SECTION 8. The division of medical assistance, in consultation with the health policy 128 commission and the department of public health, shall create a Substance Abuse and Primary 129 Care Integration pilot program within the MassHealth Primary Care Clinician Plan for patients 130 with opioid addiction seeking treatment at an opioid treatment center licensed by the department 131 of public health as defined in section 1 of chapter 111E. 132 This program shall consist of two pilot programs: one co-located patient-centered 133 medical home model pilot, and one affiliated health home pilot, leveraging bundled payments or 134 other alternative payment methodologies to integrate primary care within opioid treatment 135 centers. Each pilot program shall operate for three years, provide intensive case management 136 services, and collect outcomes data on an ongoing basis, as determined by the division of 137 medical assistance, in consultation with the health policy commission and the department of 138 public health. 9 of 12

10 139 The division of medical assistance shall issue a report annually, on or before June 30, to 140 the house and senate clerks, the house and senate committees on ways and means, the joint 141 committee on health care financing, the joint committee on mental health and substance abuse, 142 and the joint committee on public health. The report shall include a pilot program progress 143 update comparing the results of each pilot program and providing outcomes data. 144 At the conclusion of said pilots, the health policy commission shall perform an audit and 145 analysis of the pilot programs established under this section, following which, the commission 146 shall issue a report on the efficacy of the pilot programs and provide recommendations on 147 potential future payment methodologies and other incentive policies related to behavioral health 148 integration and parity. 149 SECTION 9. The department of public health shall create a public facing quality 150 outcomes dashboard. This dashboard shall report on, but not be limited to, (i) consumer 151 satisfaction responses including treatment with dignity and respect, appropriateness of services, 152 expertise of treatment staff, consumer education, and other measures with respect to the 153 provision of substance abuse services; and (ii) nationally recognized Washington Circle and 154 federal SAMHSA outcome-based measures, including, but not limited to, step-down to next 155 level of care, abstinence measures, and recidivism to higher levels of care within 14-day and day time periods. 157 All outcomes reporting and any qualitative assessments of said outcomes shall be 158 adjusted for and reflect the acuity of patients admitted to a particular service, including, but not 159 limited to, homelessness status, prior mental health treatment or diagnosis, substance abuse 160 treatment, and other co-occurring disorders; provided further that quality outcomes reported on 10 of 12

11 161 the public facing dashboard shall not be used by any insurance carrier, as defined in section 1 of 162 chapter 176O, the group insurance commission, or the division of medical assistance, to deny 163 admission, reimbursement or payment for substance abuse services. 164 Said dashboard shall also include aggregate, de-identified demographic information such 165 as age, race, ethnicity, and gender. 166 Said dashboard shall be operational on or before June 30, SECTION 10. The department of public health shall, subject to appropriation, establish a 168 community-based substance abuse walk-in center program. Location of such centers shall take 169 into account need, equitable regional access, health disparities, and other such factors as 170 determined by the department. The mission of these centers shall be to provide consumers with 171 streamlined access to substance abuse treatment services, in-person emergency and urgent 172 counseling, and coordinated transfers to treatment, when appropriate. Centers shall follow a 173 central navigation model, utilizing real-time information on treatment bed and services 174 availability across the system to efficiently refer consumers to appropriate care settings, and 175 improve access to and understanding of the substance abuse treatment system. The department 176 shall be allowed to amend contracts as needed to ensure access to real-time treatment bed and 177 services availability. 178 SECTION 11. Sections 5 and 6 shall take effect one year from the effective date of this 179 act. 180 SECTION 12. Sections 2, 4, and 7 shall take effect 60 days from the effective date of this 181 act. 11 of 12

12 182 SECTION 13. Section 8 shall take effect one year from the effective date of this act. 12 of 12